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Clinical Nutrition ESPEN Dec 2018Fluid retention is a risk factor for mortality in several medical conditions. However, the accurate and fast assessment of hydration status remains a challenge in the... (Meta-Analysis)
Meta-Analysis
Association of hyperhydration evaluated by bioelectrical impedance analysis and mortality in patients with different medical conditions: Systematic review and meta-analyses.
BACKGROUND AND AIMS
Fluid retention is a risk factor for mortality in several medical conditions. However, the accurate and fast assessment of hydration status remains a challenge in the clinical practice. Bioelectrical impedance analysis (BIA) could be an alternative to assess volume status. This systematic review aimed to evaluate the use of BIA to identify hydration status in patients with different medical conditions and to verify the association of hyperhydration, assessed by BIA, with mortality.
METHODS
This systematic review and meta-analyses included 29 studies conducted from 2002 to 2017 among different medical conditions in adults. Eligible studies were randomized and non-randomized clinical trials, prospective and retrospective observational studies. For quality assessment of studies, Effective Public Health Practice Project (EPHPP) was used.
RESULTS
Twelve studies provided data eligible for meta-analyses. A direct association between hyperhydration and mortality was observed (Odds Ratio [OR] 4.38; Confidence interval 95% [95% CI] 2.76-6.94), even when stratified for medical condition (OR 4.37; 95% CI 1.15-6.92) and BIA device (OR 4.37; 95% CI 2.75-6.92).
CONCLUSION
Hyperhydration, evaluated by BIA, was positive associated with mortality. Therefore, the prognostic impact of hyperhydration may be properly assessed by a bedside tool such as BIA.
Topics: Critical Illness; Electric Impedance; Fluid Therapy; Humans; Water-Electrolyte Balance
PubMed: 30390867
DOI: 10.1016/j.clnesp.2018.08.022 -
The Cochrane Database of Systematic... Jun 2016Fluid excess may place people undergoing surgery at risk for various complications. Hypertonic salt solution (HS) maintains intravascular volume with less intravenous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fluid excess may place people undergoing surgery at risk for various complications. Hypertonic salt solution (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. This review was published in 2010 and updated in 2016.
OBJECTIVES
To determine the benefits and harms of HS versus IS solutions administered for fluid resuscitation to people undergoing surgery.
SEARCH METHODS
In this updated review we have searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2016); MEDLINE (January 1966 to April 2016); EMBASE (January 1980 to April 2016); LILACS (January 1982 to April 2016) and CINAHL (January 1982 to April 2016) without language restrictions. We conducted the original search on April 30th, 2007, and reran it on April 8th, 2016.
SELECTION CRITERIA
We have included randomized clinical trials (RCTs) comparing HS to IS in people undergoing surgery, irrespective of blinding, language, and publication status.
DATA COLLECTION AND ANALYSIS
Two independent review authors read studies that met our selection criteria. We collected study information and data using a data collection sheet with predefined parameters. We have assessed the impact of HS administration on mortality, organ failure, fluid balance, serum sodium, serum osmolarity, diuresis and physiologic measures of cardiovascular function. We have pooled the data using the mean difference (MD) for continuous outcomes. We evaluated heterogeneity between studies by I² percentage. We consider studies with an I² of 0% to 30% to have no or little heterogeneity, 30% to 60% as having moderate heterogeneity, and more than 60% as having high heterogeneity. In studies with low heterogeneity we have used a fixed-effect model, and a random-effects model for studies with moderate to high heterogeneity.
MAIN RESULTS
We have included 18 studies with 1087 participants of whom 545 received HS compared to 542 who received IS. All participants were over 18 years of age and all trials excluded high-risk patients (ASA IV). All trials assessed haematological parameters peri-operatively and up to three days post-operatively.There were three (< 1%) deaths reported in the IS group and four (< 1%) in the HS group, as assessed at 90 days in one study. There were no reports of serious adverse events. Most participants were in a positive fluid balance postoperatively (4.4 L IS and 2.5 L HS), with the excess significantly less in HS participants (MD -1.92 L, 95% confidence interval (CI) -2.61 to -1.22 L; P < 0.00001). IS participants received a mean volume of 2.4 L and HS participants received 1.49 L, significantly less fluid than IS-treated participants (MD -0.91 L, 95% CI -1.24 to -0.59 L; P < 0.00001). The maximum average serum sodium ranged between 138.5 and 159 in HS groups compared to between 136 and 143 meq/L in the IS groups. The maximum serum sodium was significantly higher in HS participants (MD 7.73, 95% CI 5.84 to 9.62; P < 0.00001), although the level remained within normal limits (136 to 146 meq/L).A high degree of heterogeneity appeared to be related to considerable differences in the dose of HS between studies. The quality of the evidence for the outcomes reported ranged from high to very low. The risk of bias for many of the studies could not be determined for performance and detection bias, criteria that we assess as likely to impact the study outcomes.
AUTHORS' CONCLUSIONS
HS reduces the volume of intravenous fluid required to maintain people undergoing surgery but transiently increases serum sodium. It is not known if HS affects survival and morbidity, but this should be examined in randomized controlled trials that are designed and powered to test these outcomes.
Topics: Crystalloid Solutions; Fluid Therapy; Humans; Isotonic Solutions; Randomized Controlled Trials as Topic; Saline Solution, Hypertonic; Sodium; Surgical Procedures, Operative; Water-Electrolyte Balance
PubMed: 27271480
DOI: 10.1002/14651858.CD005576.pub3 -
Diabetes & Metabolic Syndrome 2015Taurine, 2-amino ethanesulfonic acid, is a conditionally essential β amino acid which is not utilized in protein synthesis. Taurine is one of the most abundant free... (Review)
Review
Taurine, 2-amino ethanesulfonic acid, is a conditionally essential β amino acid which is not utilized in protein synthesis. Taurine is one of the most abundant free amino acids in mammals tissues and is one of the three well-known sulfur-containing amino acids; the others are methionine and cysteine which are considered as the precursors for taurine synthesis. Different scientific studies emphasize on the cytoprotective properties of taurine which included antioxidation, antiapoptosis, membrane stabilization, osmoregulation, and neurotransmission. Protective and therapeutic ameliorations of oxidative stress-induced pathologies were also attributed to taurine both in experimental and human models. Data demonstrating the beneficial effectiveness of taurine against type 1 and type 2 diabetes mellitus and their complications are growing and providing a better understanding of the underlying molecular mechanisms. Although the clinical studies are limited compared to the experimental ones, the present updated systematic review of the literature is set up to provide experimental and clinical evidences regarding the effectiveness of taurine in the context of diabetes mellitus and its complications. Gathering these scientific effects of taurine on diabetes mellitus could provide the physicians and specially the endocrinologists with a comprehensive overview on possible trends in the prevention and management of the disease and its complications through antioxidant supplementation.
Topics: Anti-Inflammatory Agents; Antioxidants; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Dietary Supplements; Homeostasis; Humans; Inflammation; Oxidative Stress; Taurine
PubMed: 25366895
DOI: 10.1016/j.dsx.2014.05.001 -
Pediatric Nephrology (Berlin, Germany) Jun 2014Cystic fibrosis per se can sometimes lead to hyponatremia, hypokalemia, hypochloremia or hyperbicarbonatemia. This tendency was first documented 60 years ago and has... (Review)
Review
BACKGROUND
Cystic fibrosis per se can sometimes lead to hyponatremia, hypokalemia, hypochloremia or hyperbicarbonatemia. This tendency was first documented 60 years ago and has subsequently been confirmed in single case reports or small case series, most of which were retrospective. However, this issue has not been addressed analytically. We have therefore systematically reviewed and analyzed the available literature on this subject.
METHODS
This was a systematic review of the literature.
RESULTS
The reports included in this review cover 172 subacute and 90 chronic cases of electrolyte imbalances in patients with cystic fibrosis. The male:female ratio was 1.57. Electrolyte abnormalities were mostly associated with clinically inapparent fluid volume depletion, mainly affected patients aged ≤2.5 years, frequently tended to recur and often were found before the diagnosis of cystic fibrosis was established. Subacute presentation often included an history of heat exposure, vomiting, excessive sweating and pulmonary infection. History of chronic presentation, in contrast, was often inconspicuous. The tendency to hypochloremia, hypokalemia and metabolic alkalosis was similar between subacute and chronic patients, with hyponatremia being more pronounced (P < 0.02) in subacute compared to chronic presentations. Subacute cases were treated parenterally; chronic ones were usually managed with oral salt supplementation. Retention of urea and creatinine was documented in 38 % of subacute cases.
CONCLUSIONS
The findings of our review suggest that physicians should be aware that electrolyte abnormalities can occur both as a presenting and a recurring feature of cystic fibrosis.
Topics: Child; Cystic Fibrosis; Female; Humans; Male; Water-Electrolyte Balance; Water-Electrolyte Imbalance
PubMed: 24326787
DOI: 10.1007/s00467-013-2712-4 -
Physiology & Behavior May 2019Hypohydration is generally considered to have a negative effect on cognitive function, despite several studies reporting comparable findings between hydration states.... (Meta-Analysis)
Meta-Analysis
Hypohydration is generally considered to have a negative effect on cognitive function, despite several studies reporting comparable findings between hydration states. Recommendations to avoid moderate dehydration (≥ 2% loss in body mass) are commonly made to athletes, on the provision that this deficit may impair optimal cognitive performance. To determine whether cognitive function is impaired by hypohydration, and investigate the existence of the proposed critical water deficit of ≥2% loss in body mass purported to diminish cognitive performance, we conducted a systematic search of the literature and examined appropriate studies by meta-analysis. Overall, cognitive performance was not found to be impaired by hypohydration (g = -0.177; 95% CI = -0.532-0.179; P = .331). Nor were the underlying cognitive domains (complex attention, executive function, learning and memory) impaired (all P > .236), independent of the incurred fluid loss (less than or >2% loss in body mass), although results were not always homogenous (I ranging between 0% and 93%). Collectively, these results suggest that hypohydration may not compromise cognitive function, nor any of the investigated subdomains to a greater extent than if euhydration had been maintained. Furthermore, recommendations to avoid moderate hypohydration on the basis of maintaining optimal cognitive function are not substantiated by this meta-analysis.
Topics: Athletes; Attention; Cognition; Dehydration; Executive Function; Humans; Water-Electrolyte Balance
PubMed: 30876770
DOI: 10.1016/j.physbeh.2019.03.008 -
International Journal of Nursing... Jun 2003Dehydration is the most common fluid and electrolyte imbalance in older adults. The objectives were to identify the factors that increase the risk of dehydration in... (Review)
Review
Dehydration is the most common fluid and electrolyte imbalance in older adults. The objectives were to identify the factors that increase the risk of dehydration in older adults, how best to assess the risk and manage oral fluid intake. Data sources included Medline, CINAHL, Cochrane Library, Embase and Current Contents, which were searched until February 2002. Randomized controlled trials for management of adequate fluid intake were undertaken. Cohort and case control studies were used for the identification of risk factors for dehydration. Studies of assessment tools for the identification of dehydration were also considered. Results show that there is no clear determination of the risk factors for dehydration and decreased fluid intake. The recommended daily intake of fluids should be not less than 1600 mL/24 h in order to ensure adequate hydration. A fluid intake sheet and urine specific gravity might be the best methods of monitoring daily fluid intake. Regular presentation of fluids to bedridden older adults can maintain adequate hydration status. In conclusion, more research is required to determine the optimum method of maintaining adequate oral hydration in older adults.
Topics: Activities of Daily Living; Aged; Clinical Nursing Research; Dehydration; Fluid Therapy; Geriatric Assessment; Geriatric Nursing; Humans; Nursing Assessment; Rehydration Solutions; Research Design; Risk Factors; Water-Electrolyte Balance
PubMed: 12801253
DOI: 10.1046/j.1440-172x.2003.00425.x -
Ultrasound in Medicine & Biology May 2021Lung ultrasonography is accurate in detecting pulmonary edema and overcomes most limitations of traditional diagnostic modalities. Whether use of lung...
Lung ultrasonography is accurate in detecting pulmonary edema and overcomes most limitations of traditional diagnostic modalities. Whether use of lung ultrasonography-guided management has an effect on cumulative fluid balances and other clinical outcomes remains unclear. In this systematic review, we included 12 studies using ultrasonography guided-management with a total of 2290 patients. Four in-patient studies found a reduced cumulative fluid balance (ranging from -0.3 L to -2.4 L), whereas three out-patient studies found reduction in dialysis dry weight (ranging from -2.6 kg to -0.2 kg) compared with conventionally managed patients. None of the studies found adverse effects related to hypoperfusion. The use of lung ultrasonography-guided management was not associated with other clinical outcomes. This systematic review shows that lung ultrasonography-guided management, exclusively or in concert with other diagnostic modalities, is associated with a reduced cumulative fluid balance. Studies thus far have not shown a consistent effect on clinical outcomes.
Topics: Humans; Lung; Pulmonary Edema; Renal Dialysis; Treatment Outcome; Ultrasonography; Water-Electrolyte Balance
PubMed: 33637390
DOI: 10.1016/j.ultrasmedbio.2021.01.024 -
Minerva Endocrinologica Dec 2014In the last decade, few substances have been discussed as controversially as vitamin D. In the last few years, vitamin D research has now also found its way into the... (Review)
Review
In the last decade, few substances have been discussed as controversially as vitamin D. In the last few years, vitamin D research has now also found its way into the intensive care unit (ICU). Vitamin D deficiency is commonly found in the ICU and is associated with adverse outcomes including excess mortality, longer length of stay, higher sepsis incidence, longer mechanical ventilation. But how should one single vitamin be capable of such an impact? It has to be kept in mind that vitamin D is not a classic vitamin at all. It can be synthesized in sufficient amounts by the human body, it has a nuclear receptor and a large number of genes are under direct or indirect control of vitamin D. Furthermore, both the vitamin D receptor and the 1-α hydroxylase which is required to activate vitamin D are widely distributed in the human body. Unfortunately, as in other settings, a large body of observational data is opposed to only a few intervention studies. This article seeks to review the current observational and interventional literature concerning vitamin D status in the context of critical care, its effects on this highly vulnerable population and possible treatment strategies as well as an outlook on research that is necessary in the future.
Topics: Age Factors; Artifacts; Clinical Trials as Topic; Cohort Studies; Critical Care; Critical Illness; Double-Blind Method; Gene Expression Regulation; Humans; Immune System; Intensive Care Units; Meta-Analysis as Topic; Multicenter Studies as Topic; Observational Studies as Topic; Prognosis; Receptors, Calcitriol; Treatment Outcome; Vitamin D; Vitamin D Deficiency; Water-Electrolyte Balance
PubMed: 25069844
DOI: No ID Found -
The National Medical Journal of India 2019Administration of intravenous fluids is the most common therapy given to patients admitted to a hospital. Evidence suggests that the use of normal saline (NS) in large... (Meta-Analysis)
Meta-Analysis
Administration of intravenous fluids is the most common therapy given to patients admitted to a hospital. Evidence suggests that the use of normal saline (NS) in large quantities is not without adverse effects. Balanced salt solutions (BSS) contain bicarbonate or one of its precursors that act as a buffer, and the electrolyte composition resembles that of plasma. We reviewed studies across different setups such as intensive care units (ICUs), major surgeries, renal transplants and emergency departments to identify the effect(s) of NS and to find evidence favouring the use of BSS over NS. The use of NS is strongly associated with hyperchloraemic acidosis in almost all the studies. In the largest and latest trial in ICUs, it was found that higher chloride levels were associated with renal injury. No significant difference was found in mortality in any of the trials. In surgical patients, studies found only transient hyperchloraemia and increase in the base deficit in patients receiving NS. Systematic reviews and meta-analyses did not find any significant differences in adverse outcomes such as the need for renal replacement therapy or mortality with the use of saline; however, blood chloride levels were consistently higher with saline compared to BSS. There is a need for larger trials with better methodology to determine if the physiological benefits of BSS translate into better clinical outcomes.
Topics: Acute Disease; Adult; Child; Child, Preschool; Critical Care; Crystalloid Solutions; Humans; Infant; Water-Electrolyte Balance
PubMed: 32769243
DOI: 10.4103/0970-258X.291297 -
PloS One 2018The cultivation of bananas and other plants is limited by environmental stresses caused by climate change. In order to recognize physiological, biochemical and molecular...
BACKGROUND
The cultivation of bananas and other plants is limited by environmental stresses caused by climate change. In order to recognize physiological, biochemical and molecular components indicated to confer tolerance to water stress in Musa spp. we present the first systematic review on the topic.
METHODS
A systematic literature review was conducted using four databases for academic research (Google Academic, Springer, CAPES Journal Portal and PubMed Central). In order to avoid publication bias, a previously established protocol and inclusion and exclusion criteria were used.
RESULTS
The drought tolerance response is genotype-dependent, therefore the most studied varieties are constituted by the "B" genome. Tolerant plants are capable of super-expressing genes related to reisistance and defense response, maintaining the osmotic equilibrium and elimination of free radicals. Furthermore, they have higher amounts of water content, chlorophyll levels, stomatic conductance and dry root matter, when compared to susceptible plants.
CONCLUSIONS
In recent years, few integrated studies on the effects of water stress on bananas have been carried out and none related to flood stress. Therefore, we highlight the need for new studies on the mechanisms of differentially expressed proteins in response to stress regulation, post-translational mechanisms and epigenetic inheritance in bananas.
Topics: Acclimatization; Chlorophyll; Droughts; Epigenesis, Genetic; Free Radicals; Gene Expression Regulation, Plant; Musa; Organism Hydration Status; Osmoregulation; Plant Proteins; Plant Stomata; Protein Processing, Post-Translational
PubMed: 30507957
DOI: 10.1371/journal.pone.0208052